Drivers Application Form

Transcription

1 Drivers Application Form For OFFICIAL use ONLY: Date received: Comments:

2 Your Personal Details Surname: First names: Postcode: Contact Numbers: Home: Mobile: Address: Type of work preferred (please indicate1, 2, 3 in order of preference): Domestic: UK: International: Full-Time Part-Time: Weekends: Odd Days: Depot applied for: Virginia: Dublin: Do you need a work permit to take up employment in Ireland? Yes: No: Please note that all candidates invited to interview will be required to produce evidence of their eligibility to work in Ireland. Date of Birth: Are you a SMOKER? Yes: No: Please summarise briefly why you would like to become part of the Virginia team:

3 Your Medical History It is important that you FULLY complete this section, and that the CORRECT information is given. Where necessary details provided should be verifiable by your DOCTOR. 1. In the last FIVE years, have you consulted a Hospital or Specialist, or been referred as an Outpatient on problems in any of the following areas? (please tick) None Eyes Respiratory Circulatory Skin Joints and Bones 2. In the last TWO years, have you consulted a Doctor or any other health professional regarding any of the following (please tick)? None Eyes Respiratory Circulatory Skin Joints and Bones 3. Are you colour blind? Yes: No: 4. Do you require glasses for driving? Yes: No: 5. Do you require medication on a regular basis? Yes: No: Training and Qualifications Please detail any qualifications obtained or training undertaken, including the approx. date and result (please include Drivers CPC): Subject: Exam/Course: Approx. date: Result: Driver Card Details Digital Driver Card details must be provided. Failure to complete all sections will result in your application being rejected. Inserting Card Applied For, or similar wording, will NOT be accepted. Valid FROM (4a): Valid TO (4b): Licence No. (5a): Card No. (5b):

4 Your Employment History Please give details of your employment history over AT LEAST the last five years, giving your most recent position FIRST and working backwards, explaining clearly ALL gaps in your employment history (if you have insufficient space please photocopy this page and continue on the fresh sheet, attaching it to this form securely). To: Basic Pay: c Takehome: pw Your Licence Details Licence No: LGV Class(es): Expires: LGV Expiry: Total LGV Years: Does your licence carry current endorsements? Yes: No:

5 Your Driving Experience 7.5t Van: Often: Rarely: Never: Tautliners: Often: Rarely: Never: Tankers: Often: Rarely: Never: Rigids: Often: Rarely: Never: Boxes: Often: Rarely: Never: Tail Lift: Often: Rarely: Never: Artic: Often: Rarely: Never: Containers: Often: Rarely: Never: Flatbed: Often: Rarely: Never: Bulk Tipper: Often: Rarely: Never: Multi-Drop: Often: Rarely: Never: L/Hand Drive: Often: Rarely: Never: Low Loader: Often: Rarely: Never: RDC Deliveries: Often: Rarely: Never: International: Often: Rarely: Never: Fridges: Often: Rarely: Never: Walking Floors: Often: Rarely: Never: CHIP Liners: Often: Rarely: Never: Draw Bar: Often: Rarely: Never: ADR expiry date: Category: Supplementary Information Are you willing to work overtime and weekends when required? Yes: No: Do you have any pre-existing commitments which may limit your working hours? (For instance military reserve, local government etc.) Yes: No: Are you subject to any restraints which may affect your current or future employment? Yes: No: Have you ever worked for Virginia before? Yes: No: Do you have any pre-existing holidays arranged? Yes: No: If offered a position, how much notice must you give your current employer? days Have you ever been convicted of a Criminal Offence? Yes: No:

6 Next Of Kin Details Please give details of TWO points of contact in-case of emergency. Primary Contact This will be the individual we will try to contact first in the event of an emergency. Their identity and contact data will be treated in the strictest confidence and we will not contact them except in the event of an emergency. Relationship: Mobile Phone: Work Phone: Home Phone: Secondary Contact This will be the individual we will try to contact if we are unable to re ach your primary contact. Their identity and contact data will be treated in the strictest confidence and we will not contact them except in the event of an emergency. Relationship: Mobile Phone: Work Phone: Home Phone:

7 References Please give details of TWO Referees, BOTH must be previous employers, one MUST be your CURRENT EMPLOYER. (Please note that your current employer WILL NOT under any circumstances be contacted until you have been offered, and confirmed acceptance of a job with Virginia). Referee ONE Position: Company: Contacts: Telephone: Postcode: Fax: Person referred to: Position held: Dates held: Referee TWO (your CURRENT employer) Position: Company: Contacts: Telephone: Postcode: Fax: Person referred to: Position held: Dates held: Declaration As a requirement for successful employment as a driver within Virginia International Logistics, it is necessary for us to have access to certain information about you. This will include your driving licence details and as of September 2009, Driver CPC information. Employment offers will be subject to satisfactory references and authorisation from you to access these records. I confirm that the information supplied in this document is CORRECT. I understand that any false or misleading information or deliberate omissions will disqualify me from, or render me liable to dismissal from the employment of Virginia International Logistics. Print Full Signed: Date: Once complete, please return this form to our Head Office at, Virginia International Logistics, Maghera, Virginia, County Cavan, Republic of Ireland